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Vickie Thoreson Sr. Account Executive/Partner April 2013

School District of Nekoosa. Vickie Thoreson Sr. Account Executive/Partner April 2013. Topics for Today. Health Care Reform NSD Benefit Plan Impact Employee Impact. Compliance: Where Are We Now?.

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Vickie Thoreson Sr. Account Executive/Partner April 2013

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  1. School District of Nekoosa Vickie Thoreson Sr. Account Executive/Partner April 2013

  2. Topics for Today • Health Care • Reform • NSD Benefit • Plan Impact • Employee • Impact

  3. Compliance: Where Are We Now? • On June 28th, U.S. Supreme Court upheld the constitutionality of Affordable Care Act (ACA) • Rationale based on Congress’ power to tax, not usual Commerce Clause power • On November 6, 2012, President Obama won re-election, solidifying the future of the PPACA

  4. New HCR Taxes & Fees that will trickle down to the Nekoosa School District • PCORI $1 pmpm 1st year; $2 pmpm 2nd year *2014 • Patient-Centered Outcomes Research Institute • Insurer Fees – 2.3% of premium *2014 • Transitional Reinsurance Fee *2014 $5.65 pmpm ($63 pmpy) • Risk Adjustment Fee *2014 < $1 pmpm (healthy vs unhealthy) • Exchange Tax *2014 Insurer pays to participate in the Exchange *Insurer pays but will trickle down to your premium

  5. What we know • If no changes are made, the Cadillac tax for the Nekoosa School District will be approximately $341,000 in 2018 • *Assumes 10% annual trend, and carrier will likely raise premiums accordingly

  6. Cadillac Excise Tax - 2018 40% tax on premium that exceeds HCR premium benchmark Annual Premiums 2018 2019 2020 2013-2014 NSD Premium (s)$9,022 (f) $19,885

  7. Employee/Individual What’s next 2014 American Health Benefit Exchanges

  8. What Can We Do to Prepare? Primary Care Specialty Care Bid the Market Healthier Population WEA Base Plan Wellness Plan

  9. Healthier Population Watch for Wellness Committee news in the coming months! • Stay healthy • Get healthier • Be wise consumers of our medical plan

  10. WEA Trust Base Plan – What is it? • Aligns with the market benefit designs • Aligns with State mandated benefits • Introduces $100 co-payment for non-emergency high cost radiology such as CAT, PET & MRI

  11. WEA Trust Base Plan • Encourages network usage with separate out-of-pocket • Benefit impact is minimal to District members • Will impact very small % of members • Many schools changing to this benefit design

  12. Primary & Specialty Care Primary Care • Family Practice • General Practice • OB GYN • Pediatrics • Geriatrics • Internal Medicine

  13. Primary & Specialty Care Specialty Care • Devotes attention to a particular branch of medicine • Cardiologist • Psychiatrist • Rheumatologist • Oncologist

  14. Primary & Specialty Care • Specialist office visit is typically 3-4 times more costly • We oftentimes “self refer” to specialist

  15. Primary & Specialty Care • Effective July 1st 2013 • $10 Primary Care Co-Payment • $25 Specialty Care Co-Payment Don’t forget to use your Flex Plan!!

  16. We’re here to help

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